Remote Medical Coding Auditor

Humana; Harrisburg (Dauphin County); Remote; USD 59,000 - 81,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana seeks a Medical Coding Auditor to review outpatient claims, ensure CPT/HCPCS accuracy, and support correct provider payments. This remote role involves analyzing documentation, CPT/HCPCS reviews, and peer audits while safeguarding PHI/HIPAA data.

Travel to Humana offices may be required for training. Requires CPC/COC/CCS/ROCC/RHIA/RHIT certification with 3+ years post-cert experience and strong CPT/HCPCS knowledge.

Qualifications

• CPC, COC, CCS, ROCC, RHIA, or RHIT Certification with a minimum of 3 years post-certification experience
• Minimum of 3 years post certification experience Outpatient Specialty Surgeries and Procedures
• Strong knowledge of CPT/HCPCS coding
• Experience reading & coding from operative reports
• Chemotherapy and/or Therapeutic Infusion experience
• Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
• Strong attention to detail, can work independently and determine appropriate course of action, & ability to handle multiple priorities
• Comfortable working in a production-based work environment
• Ability to work independently and manage workload
• Strong written and verbal communication skills; strong analytical, organizational and time management skills
• Working knowledge of Microsoft Office Programs (Word, Excel)
• 5+ years prior coding experience
• Outpatient facility auditing experience
• Experience with coding/auditing Radiology, Gastroenterology, Urinary, Musculoskeletal, Integumentary, Anesthesia, General Surgery, Cardiology, Respiratory, Infusion, Interventional Radiology, Outpatient Itemized Bill reviews
• Ambulatory Payment Classification (APC) coding experience
• Radiation Oncology coding experience
• Experience in prospective payment methodologies
• Experience with the Claims Life Cycle including Accounts Receivable
• 3M Coder software experience

Responsibilities

• Verify and ensure the accuracy, completeness, specificity and appropriateness of procedure codes based on services rendered
• Review medical documentation for clinical indicators to ensure specific procedures meet clinical criteria and correct coding guidelines specific to Ambulatory Payment Classification (APC) and Outpatient Facility coding
• Utilize encoders and various coding resources
• Perform CPT/HCPCS Procedure reviews
• Conduct peer reviews to ensure compliance with coding guidelines and provide reports as needed
• Maintain strict patient and physician confidentiality and follow all federal, state and hospital guidelines for release of information
• Maintain current working knowledge of ICD-10 and CPT coding guidelines, government regulation and protocols
• Complete appropriate system(s) entry regarding claim/encounter information
• Support and participate in process and quality improvement initiatives

Skills

CPT/HCPCS coding

Operative report coding

Strong written and verbal comms

Attention to detail

Independent worker

Production environment

Microsoft Office knowledge

Education

CPC/COC/CCS/ROCC/RHIA/RHIT Certification

Tools

Microsoft Word

Microsoft Excel

Job description

Humana seeks a Medical Coding Auditor to review outpatient claims, ensure CPT/HCPCS accuracy, and support correct provider payments. This remote role involves analyzing documentation, CPT/HCPCS reviews, and peer audits while safeguarding PHI/HIPAA data.

Travel to Humana offices may be required for training. Requires CPC/COC/CCS/ROCC/RHIA/RHIT certification with 3+ years post-cert experience and strong CPT/HCPCS knowledge.